Exploring the Use of a Social Determinants of Health Focused History Script to Facilitate Patient Conversations

Abstract

Context Screening for social determinants of health (SDOH) factors is fundamental to addressing barriers to health outcomes and identifying resources needed to provide patient-centered care. However, SDOH can be a difficult area of patient care to navigate without a screening tool. Objective To explore athletic training students’ abilities to screen for SDOH factors via standardized patient (SP) encounters and to describe the experience of screening for SDOH factors. Design Prospective, mixed-methods cohort study. Setting Simulation laboratory. Patients or Other Participants Fifty-four postbaccalaureate professional athletic training students (women = 43, men = 11; age = 23 ± 1 years). Intervention The same SP encounter was completed with 2 cohorts of athletic training students, with 1 intervention cohort (n = 29) screening for the SDOH without an aide and the control cohort (n = 25) screening with the mandatory use of a validated SDOH focused history script. Main Outcome Measures The SP encounters were evaluated using a tool containing an SDOH evaluation by domain and Athletic Training Milestone competencies. Following the SP encounter, each learner completed a postlearning survey. Data were analyzed using descriptive statistics, Mann-Whitney U tests, and thematic qualitative analysis. Results We identified a significant difference (P ≤ .001) for the overall screening for the SDOH, with the intervention cohort that was required to use the focused history script scoring significantly higher than the control cohort. The intervention cohort scored significantly higher (P ≤ .001) on the Athletic Training Milestones than the control cohort, but the intervention cohort self-rated their performance as lower during the reflection. Conclusion The use of the focused history script during the SP encounter highlighted the need for a screening tool to be present during the evaluation to facilitate a conversation about the SDOH. When health care students were not required to use the focused history script to screen for the SDOH, most failed to elicit information about the SDOH factors or performed poorly during the screening.